Increasing time to operation is associated with decreased survival in patients with a positive FAST examination requiring emergent laparotomy

Ronald R. Barbosa, Susan Rowell, Erin E. Fox, John B. Holcomb, Eileen M. Bulger, Herb A. Phelan, Louis H. Alarcon, John G. Myers, Karen Brasel, Peter Muskat, Deborah J. Del Junco, Bryan A. Cotton, Charles E. Wade, Mohammad H. Rahbar, Mitchell J. Cohen, Martin Schreiber

    Research output: Contribution to journalArticle

    19 Citations (Scopus)

    Abstract

    INTRODUCTION: Focused assessment with sonography for trauma (FAST) is commonly used to facilitate the timely diagnosis of life-threatening hemorrhage in injured patients. Most patients with positive findings on FAST require laparotomy. Although it is assumed that an increasing time to operation (T-OR) leads to higher mortality, this relationship has not been quantified. This study sought to determine the impact of T-OR on survival in patients with a positive FAST who required emergent laparotomy. METHODS: We retrospectively analyzed patients from the PRospective Observational Multicenter Major Trauma Transfusion (PROMMTT) study who underwent laparotomy within 90 minutes of presentation and had a FAST performed. Cox proportional hazards models including Injury Severity Score (ISS), age, base deficit, and hospital site were created to examine the impact of increasing T-OR on in-hospital survival at 24 hours and 30 days. The impact of time from the performance of the FAST examination to operation (TFAST-OR) on in-hospital mortality was also examined using the same model. RESULTS: One hundred fifteen patients met study criteria and had complete data. Increasing T-OR was associated with increased inhospital mortality at 24 hours (hazard ratio [HR], 1.50 for each 10-minute increase in T-OR; confidence interval [CI], 1.14-1.97; p = 0.003) and 30 days (HR, 1.41; CI, 1.18-2.10; p = 0.002). Increasing TFAST-OR was also associated with higher in-hospital mortality at 24 hours (HR, 1.34; CI, 1.03-1.72; p = 0.03) and 30 days (HR, 1.40; CI, 1.06-1.84; p = 0.02). CONCLUSION: In patients with a positive FAST who required emergent laparotomy, delay in operation was associated with increased early and late in-hospital mortality. Delays in T-OR in trauma patients with a positive FAST should be minimized.

    Original languageEnglish (US)
    JournalJournal of Trauma and Acute Care Surgery
    Volume75
    Issue number1 SUPPL1
    DOIs
    StatePublished - 2013

    Fingerprint

    Laparotomy
    Ultrasonography
    Survival
    Wounds and Injuries
    Hospital Mortality
    Confidence Intervals
    Injury Severity Score
    Proportional Hazards Models
    Hemorrhage
    Mortality

    Keywords

    • FAST examination
    • Laparotomy
    • PROMMTT
    • Time to operation

    ASJC Scopus subject areas

    • Critical Care and Intensive Care Medicine
    • Surgery

    Cite this

    Increasing time to operation is associated with decreased survival in patients with a positive FAST examination requiring emergent laparotomy. / Barbosa, Ronald R.; Rowell, Susan; Fox, Erin E.; Holcomb, John B.; Bulger, Eileen M.; Phelan, Herb A.; Alarcon, Louis H.; Myers, John G.; Brasel, Karen; Muskat, Peter; Del Junco, Deborah J.; Cotton, Bryan A.; Wade, Charles E.; Rahbar, Mohammad H.; Cohen, Mitchell J.; Schreiber, Martin.

    In: Journal of Trauma and Acute Care Surgery, Vol. 75, No. 1 SUPPL1, 2013.

    Research output: Contribution to journalArticle

    Barbosa, RR, Rowell, S, Fox, EE, Holcomb, JB, Bulger, EM, Phelan, HA, Alarcon, LH, Myers, JG, Brasel, K, Muskat, P, Del Junco, DJ, Cotton, BA, Wade, CE, Rahbar, MH, Cohen, MJ & Schreiber, M 2013, 'Increasing time to operation is associated with decreased survival in patients with a positive FAST examination requiring emergent laparotomy', Journal of Trauma and Acute Care Surgery, vol. 75, no. 1 SUPPL1. https://doi.org/10.1097/TA.0b013e31828fa54e
    Barbosa, Ronald R. ; Rowell, Susan ; Fox, Erin E. ; Holcomb, John B. ; Bulger, Eileen M. ; Phelan, Herb A. ; Alarcon, Louis H. ; Myers, John G. ; Brasel, Karen ; Muskat, Peter ; Del Junco, Deborah J. ; Cotton, Bryan A. ; Wade, Charles E. ; Rahbar, Mohammad H. ; Cohen, Mitchell J. ; Schreiber, Martin. / Increasing time to operation is associated with decreased survival in patients with a positive FAST examination requiring emergent laparotomy. In: Journal of Trauma and Acute Care Surgery. 2013 ; Vol. 75, No. 1 SUPPL1.
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    abstract = "INTRODUCTION: Focused assessment with sonography for trauma (FAST) is commonly used to facilitate the timely diagnosis of life-threatening hemorrhage in injured patients. Most patients with positive findings on FAST require laparotomy. Although it is assumed that an increasing time to operation (T-OR) leads to higher mortality, this relationship has not been quantified. This study sought to determine the impact of T-OR on survival in patients with a positive FAST who required emergent laparotomy. METHODS: We retrospectively analyzed patients from the PRospective Observational Multicenter Major Trauma Transfusion (PROMMTT) study who underwent laparotomy within 90 minutes of presentation and had a FAST performed. Cox proportional hazards models including Injury Severity Score (ISS), age, base deficit, and hospital site were created to examine the impact of increasing T-OR on in-hospital survival at 24 hours and 30 days. The impact of time from the performance of the FAST examination to operation (TFAST-OR) on in-hospital mortality was also examined using the same model. RESULTS: One hundred fifteen patients met study criteria and had complete data. Increasing T-OR was associated with increased inhospital mortality at 24 hours (hazard ratio [HR], 1.50 for each 10-minute increase in T-OR; confidence interval [CI], 1.14-1.97; p = 0.003) and 30 days (HR, 1.41; CI, 1.18-2.10; p = 0.002). Increasing TFAST-OR was also associated with higher in-hospital mortality at 24 hours (HR, 1.34; CI, 1.03-1.72; p = 0.03) and 30 days (HR, 1.40; CI, 1.06-1.84; p = 0.02). CONCLUSION: In patients with a positive FAST who required emergent laparotomy, delay in operation was associated with increased early and late in-hospital mortality. Delays in T-OR in trauma patients with a positive FAST should be minimized.",
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    T1 - Increasing time to operation is associated with decreased survival in patients with a positive FAST examination requiring emergent laparotomy

    AU - Barbosa, Ronald R.

    AU - Rowell, Susan

    AU - Fox, Erin E.

    AU - Holcomb, John B.

    AU - Bulger, Eileen M.

    AU - Phelan, Herb A.

    AU - Alarcon, Louis H.

    AU - Myers, John G.

    AU - Brasel, Karen

    AU - Muskat, Peter

    AU - Del Junco, Deborah J.

    AU - Cotton, Bryan A.

    AU - Wade, Charles E.

    AU - Rahbar, Mohammad H.

    AU - Cohen, Mitchell J.

    AU - Schreiber, Martin

    PY - 2013

    Y1 - 2013

    N2 - INTRODUCTION: Focused assessment with sonography for trauma (FAST) is commonly used to facilitate the timely diagnosis of life-threatening hemorrhage in injured patients. Most patients with positive findings on FAST require laparotomy. Although it is assumed that an increasing time to operation (T-OR) leads to higher mortality, this relationship has not been quantified. This study sought to determine the impact of T-OR on survival in patients with a positive FAST who required emergent laparotomy. METHODS: We retrospectively analyzed patients from the PRospective Observational Multicenter Major Trauma Transfusion (PROMMTT) study who underwent laparotomy within 90 minutes of presentation and had a FAST performed. Cox proportional hazards models including Injury Severity Score (ISS), age, base deficit, and hospital site were created to examine the impact of increasing T-OR on in-hospital survival at 24 hours and 30 days. The impact of time from the performance of the FAST examination to operation (TFAST-OR) on in-hospital mortality was also examined using the same model. RESULTS: One hundred fifteen patients met study criteria and had complete data. Increasing T-OR was associated with increased inhospital mortality at 24 hours (hazard ratio [HR], 1.50 for each 10-minute increase in T-OR; confidence interval [CI], 1.14-1.97; p = 0.003) and 30 days (HR, 1.41; CI, 1.18-2.10; p = 0.002). Increasing TFAST-OR was also associated with higher in-hospital mortality at 24 hours (HR, 1.34; CI, 1.03-1.72; p = 0.03) and 30 days (HR, 1.40; CI, 1.06-1.84; p = 0.02). CONCLUSION: In patients with a positive FAST who required emergent laparotomy, delay in operation was associated with increased early and late in-hospital mortality. Delays in T-OR in trauma patients with a positive FAST should be minimized.

    AB - INTRODUCTION: Focused assessment with sonography for trauma (FAST) is commonly used to facilitate the timely diagnosis of life-threatening hemorrhage in injured patients. Most patients with positive findings on FAST require laparotomy. Although it is assumed that an increasing time to operation (T-OR) leads to higher mortality, this relationship has not been quantified. This study sought to determine the impact of T-OR on survival in patients with a positive FAST who required emergent laparotomy. METHODS: We retrospectively analyzed patients from the PRospective Observational Multicenter Major Trauma Transfusion (PROMMTT) study who underwent laparotomy within 90 minutes of presentation and had a FAST performed. Cox proportional hazards models including Injury Severity Score (ISS), age, base deficit, and hospital site were created to examine the impact of increasing T-OR on in-hospital survival at 24 hours and 30 days. The impact of time from the performance of the FAST examination to operation (TFAST-OR) on in-hospital mortality was also examined using the same model. RESULTS: One hundred fifteen patients met study criteria and had complete data. Increasing T-OR was associated with increased inhospital mortality at 24 hours (hazard ratio [HR], 1.50 for each 10-minute increase in T-OR; confidence interval [CI], 1.14-1.97; p = 0.003) and 30 days (HR, 1.41; CI, 1.18-2.10; p = 0.002). Increasing TFAST-OR was also associated with higher in-hospital mortality at 24 hours (HR, 1.34; CI, 1.03-1.72; p = 0.03) and 30 days (HR, 1.40; CI, 1.06-1.84; p = 0.02). CONCLUSION: In patients with a positive FAST who required emergent laparotomy, delay in operation was associated with increased early and late in-hospital mortality. Delays in T-OR in trauma patients with a positive FAST should be minimized.

    KW - FAST examination

    KW - Laparotomy

    KW - PROMMTT

    KW - Time to operation

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